HomeMy WebLinkAboutHomestead_FahrnerY, CLAIM FOR HOMESTEAD PROPERTY TAX FORM
ar CREDIT /STANDARD DEDUCTION HC10
,! State Form 5473 (R2 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
'. "r'CERTIFICATION STATEN
I (We) rtify that on the 1st day of March, 19_
I (We) occupied as our principal place of residence the following described el property for which a Homestead Property Tax Credit is hereby claimed:
❑
l(We)owned ❑ Are buying under contract (L.1 � (r perty
?lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns.the pro or,is.bu(yiing.under a contract.
GCR , - goon
CONTRACT RECORDED. `•" —' vv n„;� > ^•,'.
If haying on contras. Fee Simple owners name r
Recorders oHiW where contract is recorded /V clpsro" Record number" ' — Page
.- PROPERTY DESCRIPTION —_ -
County
Township
Taxing ////���- /-/77��'--yy-- (s t n, towns rp)
Parcel number
L al description
If any portion of the residential structure or the land not exceeding one (1) acre that irrifnediately, surrounds that stmt re is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES.
TRUE TAX
VALUE
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sig lure of claimant
dress (number and street. ary, slate. ZIP code)
Otherland
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL-
VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(11
- -
Otherland
(2);
Total land (line I plus line 2))
(3)
Residential improvements
Dwelling
(4)
-
s
Garage
(5)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pI/s line 7)
(8)
hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
verifying action - Signature of Auditor
Date signetl